Do health professionals make the best OHS leaders?

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David Michaels has been nominated by President Obama as the new Assistant Secretary for the Occupational Safety and Health Administration in the Department of Labor.  (A brief profile of Michaels is available HERE.)  A posting at a US Workers’ Compensation website links through to a discussion on the potential impacts of the Michaels’ appointment.

There are several telling quotes in the podcast.  Sidney Shapiro, a law professor at Wake Forest University, says that OHS achieves more when run by someone with a health professional background.

“…I think it’s important that we know that David Michaels is a health professional.  And I think OSHA’s done best when it’s had administrators from the public health community.  It is, after all, a public health agency.  More times than many of us would wish, it’s been headed by someone who’s been an adamant critic of OSHA and has come from industry or been an industry lawyer.”

Whether this position can be applied to regulators in other jurisdictions is an interesting question.

The Chair of the UK HSE Board, Judith Hackett,  has a background in petrochemicals.  The CEO of the HSE, Geoffrey Podger, has a background in the civil service, health and food safety.   The chair of the Safe Work Australia Council, Tom Phillips was the former CEO of car manufacturer, Mitsubishi, and has served on a range of industrial company boards in South Australia.  The Chair of WorkSafe BC board, Roslyn Kunin, harks from human resources and the labour market.   Greg Tweedly CEO of WorkSafe Victoria has a background in insurance and compensation.  Nina Lyhne of WorkSafe WA comes from road safety and compensation.

This unrepresentative sample shows a mix of experience and not all from health promotion.  If the list was comprehensive, it would be interesting to see if Shapiro’s comments stack up and to see how many trade union officials have moved to “the top” or will simply remain “on the board”.

The Living on Earth podcast includes the following quote from Michaels from some time ago:

“What polluters have seen is that the strategy that the tobacco industry came up with, which essentially is questioning the science, find the controversy and magnify that controversy, is very successful in slowing down public health protections.  And so the scientists who used to work for the tobacco industry are now working for most major chemical companies.  They don’t have to show a chemical exposure is safe.  All they have to do is show that the other studies are in question somehow.  And by raising that level of uncertainty, they throw essentially a monkey wrench into the system.”

This statement could generate optimism for OSHA’s future but there are many examples of the views of environmentalists changing once they move into the corporate world.  Politicians like Australia’s Minister for the Environment, Peter Garrett, is an obvious recent Australian example.  Harry Butler in the 1970s was roundly criticised for “selling out” to the petrochemical industry.

However, the appointment of David Michaels pans out, it will be an interesting one to watch, particularly if the US Democrats can stay in power for more than Obama’s two terms.

Kevin Jones

Cass Sunstein, Risk, Cost-Benefit and OHS – Part 2

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Part 2 of Risk & Reason book review from SafetyAtWork magazine 2003

review-4i11-2

Sunstein closes the chapter “Thinking About Risks” with a short reference to September 11 2001 with which he says that “acts of terrorism show an acute appreciation of the psychological phenomena..”

Throughout the book, there are snippets that can be related to safety management.  For instance, he writes of “dreaded deaths” with 3 points:

  1. People can adapt to suffering much better than they think they can.
  2. Some pain and suffering may well be an inevitable part of a desirable period in which people…can plan and adapt themselves to the fact of death…(p.66)
  3. The period of pain and suffering that precedes death ought… to be far less important… than the fact of death itself.”

These points relate to HIV and cancer principally, but can’t we obtain some constructive advantage from having our employees dread workplace or traumatic deaths?   First aid training often raises safety awareness because the First Aiders dread having to apply their skills.  We drive cautiously because we dread traumatic injuries to our family and ourselves.  Dread can lead to caution which leads to safe work.

Sunstein chooses not to deal with the relationship between risk and culture and directs us to “Risk & Culture” by Douglas and Wildavsky (1992).  It is fair to acknowledge intellectual limitations but the whole book operates through, predominantly, the concerns of the United States culture and values.  The cultural values of the US are not universal and some admission of this variation would have been useful, particularly given that the Douglas and Wildavsky book was published well over 10 years ago.

The illustration of eight propositions for cost-benefit analysis and government decision-making is very useful.   They support the integration of qualitative measurements and a broad application of “costs”.   One proposition is that “agencies should be required to show that the benefits justify the costs.  If they do not, they should be required to show that the action is nonetheless reasonable…” Accountability is now an essential element of all business areas.

Risk and Reason may prove to be invaluable to United States readers but information for others was difficult to extract.  (The testimonials on the dust jacket are glowing but are all academic, although one is from outside the US).   There is no obligation for writers to include readers outside of their own marketplace but on an issue like risk and in a context of environmental management, it is disappointing that the book does not acknowledge the global readership.   As mentioned above even very well known risk experts are not even referenced.   The book is parochial and does not acknowledge that international standards do affect the US legal system even if it is less than in other jurisdictions.  Environmental issues cross territorial boundaries and are becoming more involved with global legal structures and obligations.

Cass Sunstein has a good writing style and it is not difficult to read.  We can only hope that the publishers encourage Mr Sunstein to write a complementary book focussing on risk and reason outside the United States.

The best pathway to Cass Sunstein information and writings is through his listing at Wikipedia.  However, I did enjoy reading this article.

Cass Sunstein, Risk, Cost-Benefit and OHS

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On 26 January 2009, the Los Angeles Times reported on the appointment of Cass Sunstein as the “regulatory czar” under Barack Obama’s presidency.  He is to be appointed the head of The Office of Information and Regulatory Affairs.

In 2003 in the precursor to the SafetyAtWorkBlog, SafetyAtWork magazine, I reviewed Sunstein’s book – Risk & Reason, Safety, Law and the Environment.  Below is the first part of that review

SafetyAtWork magazine Vol 4 Issue 11 - 2003
SafetyAtWork magazine Vol 4 Issue 11 - 2003

So many safety professionals also have responsibility for the environment that Risk & Reason – Safety, Law, and the Environment seemed an attractive read.  This book is unashamedly North American and to some extent that is a discouragement but given that many innovations originated there, the book was worth a look.

From outside North America the issues of most relevance were those concerning risk perception and the role of experts.  Cass Sunstein states that

Before government acts, it should, if feasible, attempt to produce a cost benefit analysis, understood as a detailed accounting of the consequences of the alternative courses of action.  The cost benefit analysis should allow people to see if the problem at issue is small or large.  It should explore the expense of reducing the problem and explain who will bear that expense.  (p. ix)

He says that,

Some people think of cost benefit analysis as a form of cold, barely human calculation, treating health and life as mere commodities and envisioning government as some kind of huge maximizing machine.  On the contrary, I urge that cost-benefit analysis should be seen as a simple pragmatic tool, designed to promote a better appreciation of the consequences of regulation.  (p.ix)

I wondered whether what he considers cost -benefit analysis in the broadest sense.  His concepts fit with risk management and, of course, risk management is supported by various standards such as AS4360.

The trap with cost-benefit analysis is that decisions made are cold and barely human, which he acknowledges.  He uses the fuel economy standard as an example.

If, for example, proposed fuel economy standards will significantly reduce greenhouse gases but also lead to smaller and less safe cars -and thus produce over a thousand extra deaths each year – officials and citizens should be aware of that fact.  (P. ix)

Here is a crucial question for the book – what is the more important, the needs of the many, or the needs of the few.  In his introduction, he surprisingly uses an example of the Hatfield rail crash in the United Kingdom.  Sunstein discusses how people now perceive rail transport as unsafe and began driving to work, a far more statistically dangerous activity.  This example is proceeding well until he stumbles.  He says that

After the crash, people undoubtedly spoke with one another about their fears, creating a kind of cascade of concern about train safety. We shall also see that cascade effects can lead people to large-scale errors about risks. But government regulation, my principal topic here, was not involved. (p 2)

It is clear that Sunstein is not as well informed on Hatfield as is necessary to use the example. Government regulation, or deregulation, of rail transport has never sat well with the English rail traveller.  Hatfield confirmed fears encouraging people to alternative transport methods, ones over which they have direct control.  With train travel, you place your trust in the driver and the system. In automobiles, you feel in more control.

Sunstein makes three recommendations to government on assessing regulation through cost-benefit analysis:

  • “…attempt to assess the magnitude of any problem that it is attempting to solve, through quantitative assessments to the extent possible.”
  • “…attempt to assess tradeoffs, by exploring the costs of regulation, also in quantitative terms if possible.”
  • ”   attempt to use tools that are effective and inexpensive.” (p.5)

This process would be familiar to all safety professionals. We recommend the same process to improve safety:

  • Identify
  • Assess
  • Control

This book shows that there are many parallels between environmental regulation and OHS regulation. Sunstein says

“Properly understood, a cost-benefit state attempts to make people’s lives better. The effort to quantify and to balance is designed not to assess everything in terms of money but to promote close attention to the actual consequences of what government does.” (p.8 )

Chapter 2 is very much about risk perception but suffers from not drawing more on the large amount of safety risk perception analysis and terminology. Sunstein reaches the issue of risk perception from a different point of origin. He asks,

‘What are ordinary people thinking? Can we discern some structure to their judgments? Three beliefs seem to be playing a large role. First, many people believe that risk is an “all or nothing” matter. Something is either safe or dangerous, and there is no middle ground. Second, many people are committed to a belief in the benevolence of nature. They think that the products of human beings, and human activities, are more likely to be dangerous than the products of natural processes. Third, many people subscribe to the “zero risk” mentality, at least in some domains. Such people believe that it is both possible and appropriate to abolish risk entirely, a belief that appears closely connected with the notion that risk is a matter of “all or nothing.”‘ (p.36)

Sunstein discusses Outrage without naming it and by missing this concept narrows the relevance of the book and the authority of his voice. If he had looked at any of Peter Sandman’s work on Outrage, had looked to other scholarly fields, his work would have been more authoritative. Given that Sandman’s works originated from environmental and planning issues it is very surprising that there is no reference to them, particularly given that Sandman is also a United States academic.

Sunstein says that “a possible conclusion is that, with respect to risks, vivid images and concrete pictures of disaster can ‘crowd out’ other kinds of thoughts, including the crucial thought that the probability of disaster is very small.” (p.46) How much more interesting would it have been if he had incorporated Sandman’s Outrage principle and expanded upon it?

The next part of this review will be posted tomorrow.

Workplace health initiatives in unstable economic times

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All through the Presidency of George W Bush, safety professionals have been critical of the lack of action on workplace safety.  As with many issues related to a new Democrat President in Barack Obama, organisations are beginning to publish their wishlists.  The latest is the American College of Occupational and Environmental Medicine (ACOEM).

On 9 January 2009, ACOEM released a media statement which began

“American College of Occupational and Environmental Medicine (ACOEM) calls on the Health and Human Services Secretary-designee Tom Daschle to address the critical link between the health, safety, and productivity of America’s workers and the long-term stability of its health care system and economy as he begins work on the Obama administration’s health care agenda.”

The requested changes could be interpreted as a criticism of what the situation has been under George W Bush.  ACOEM says the next government

“must put a greater emphasis on ensuring the health of the workforce in order to meet the twin challenges of an aging population and the rise of chronic disease…”

ACOEM President Robert R. Orford, MD goes into specifics

“…calling on Daschle to focus on preventive health measures aimed at workers that could range from screening and early detection programs to health education, nutritional support, and immunizations.”

The ACOEM reform program is based on the following

  • “investing in preventive health programs for workers;
  • creating new linkages between the workplace, homes and communities to reinforce good health;
  • providing financial incentives to promote preventive health behaviors among workers; and
  • taking steps to ensure that more health professionals are trained in preventive health strategies that can be applied in the workplace.”

Accepting that one Australian State, Victoria, is considerably smaller than the US (Victoria  has a population of around 5,200,000, the US had 301,621,157 in 2007), it is interesting to remember what the Victorian Government proposed (or promised) just on 12 months ago concerning its WorkHealth initiative.

“Over time the program is expected to free up $60 million per year in health costs, as well as:

  • Cut the proportion of workers at risk of developing chronic disease by 10 per cent;
  • Cut workplace injuries and disease by 5 per cent, putting downward pressure on premiums;
  •  Cut absenteeism by 10 per cent; and
  •  Boost productivity by $44 million a year.”

[It would be of little real benefit to simply multiple the Victorian commitments by the differential with the US population to compare monetary commitments, as there are too many variable but if the WorkHealth productivity was imposed on the US, there could be a $2.6 billion, not a lot considering the size of President Bush’s bailouts and Barack Obama’s mooted bailout package.  However, in the current economic climate, in order to gain serious attention, any proposal should have costs estimated up front and, ideally, show how the initiative will have minimal impact on government tax revenues – an approach that would require.]

In each circumstance there is the logic that unhealthy people are less productive than healthy people.  This sounds right but it depends very much on the type of work tasks being undertaken.  It is an accepted fact [red flag for contrary comments. ED] that modern workloads are considerably more supported by technology than in previous labour-intensive decades.  Perhaps there are better productivity gains through (further) increased automation than trying to reverse entrenched cultural activity.

In late 2008 an OHS expert said to a group of Australian safety professionals in late-2008 that WorkHealth

“is not well-supported by the stakeholders.  The trade unions feel it is a diversion away from regulated compliance and that it is going to refocus the agenda on the health of the worker and the fitness of the worker as the primary agenda, which is not what the [OHS] Act is setup to focus on. The employers are basically unkeen to get involved on issues they think are outside their control.”

The expert supported the position of some in the trade union movement that WorkHealth was always a political enthusiasm, some may say folly.

This is going to be of great importance in Australia with the possibility of new OHS legislation to apply nationally but also muddies the strategic planning of any new government that needs to show that it is an active and effective agent of change, as Obama is starting to do.  In the US, the public health system is not a paragon and the workplace safety regulatory system is variable, to be polite.  Fixing the public health system would seem to have the greater social benefit in the long term, and a general productivity benefit.

(It has to be admitted that the packaging of health care in employment contracts in the US is attractive employment benefit and one that seems to be vital to those who have it.  Australia does not have that workplace entitlement but those employers struggling to become employers-of-choice should serious consider it, particularly as a work/family benefit.)

Each country is trying to reduce the social security cost burden on government and it would seem that public health initiatives would have the broader application as it covers the whole population and not just employees, or just those employees who are unfit.

Work health proposals in both jurisdictions need to re-examine their focuses and to pitch to their strengths.  Business has enough to worry about trying to claw its way out of recession (even if the US government is throwing buckets of money to reduce the incline from the pit).  OHS professionals have enough work trying to cope with the traditional hazards and recent, more-challenging, psychosocial hazards.  Workplace health advocates are muddying the funding pool, confusing government strategic policy aims, and blending competing or complementary approaches to individual health and safety in the public’s mind.  

 Kevin Jones

Update 16 January 2009

More information on this issue is available HERE